Rello J, Soñora R, Jubert P, Artigas A, Rué M, Vallés J
Intensive Care Department, Hospital de Sabadell, Barcelona, Spain.
Am J Respir Crit Care Med. 1996 Jul;154(1):111-5. doi: 10.1164/ajrccm.154.1.8680665.
In order to assess potential risk factors for pneumonia within the first 8 d of ventilation, we studied 83 consecutive intubated patients undergoing continuous aspiration of subglottic secretions (CASS). Multivariate analysis showed the protective effect of antibiotic use (relative risk [RR] = 0.10; 95% confidence interval [CI] = 0.01 to 0.71), whereas failure of the CASS technique (RR = 5.29; 95% CI = 1.24 to 22.64) was associated with a greater risk of pneumonia. In addition, there was a trend toward a higher risk of pneumonia (RR = 2.57; 95% CI = 0.78 to 8.03) among patients with persistent intracuff pressures below 20 cm H2O. The remaining factors analyzed were not significant. Failure of CASS did not influence the development of pneumonia among patients undergoing antibiotic treatment (33.0% versus 38.5%, p > 0.20), but was strongly associated with pneumonia (42.1% versus 8.3%, p < 0.01) among intubated patients not receiving antibiotics. When multivariate analysis was repeated in this subpopulation, failure of CASS (RR = 7.52, 95% CI = 1.48 to 38.07) and persistent intracuff pressure below 20 cm H2O (RR = 4.23, 95% CI = 1.12 to 15.92) were factors independently associated with the development of pneumonia. We conclude that leakage of colonized subglottic secretions around the cuff of the endotracheal tube is the most important risk factor for pneumonia within the first 8 d of intubation. This study confirms the importance of maintaining adequate intracuff pressure and effective aspiration of subglottic secretions in preventing pneumonia in intubated patients not receiving antibiotic treatment.
为了评估通气开始后8天内发生肺炎的潜在危险因素，我们研究了83例连续接受声门下分泌物持续吸引（CASS）的插管患者。多因素分析显示使用抗生素具有保护作用（相对危险度[RR]=0.10；95%置信区间[CI]=0.01至0.71），而CASS技术失败（RR=5.29；95%CI=1.24至22.64）与肺炎风险增加相关。此外，气管套囊内压力持续低于20 cm H2O的患者发生肺炎的风险有升高趋势（RR=2.57；95%CI=0.78至8.03）。分析的其他因素无显著意义。CASS技术失败在接受抗生素治疗的患者中对肺炎的发生无影响（33.0%对38.5%，p>0.20），但在未接受抗生素治疗的插管患者中与肺炎密切相关（42.1%对8.3%，p<0.01）。在该亚组中重复进行多因素分析时，CASS技术失败（RR=7.52，95%CI=1.48至38.07）和气管套囊内压力持续低于20 cm H2O（RR=4.23，95%CI=1.12至15.92）是与肺炎发生独立相关的因素。我们得出结论，气管内导管套囊周围定植的声门下分泌物渗漏是插管后8天内发生肺炎的最重要危险因素。本研究证实了在未接受抗生素治疗的插管患者中维持足够的套囊内压力和有效吸引声门下分泌物对预防肺炎的重要性。
